Maki Sugimoto, MD, PhD. Kobe University
The surgical simulation and training in the actual operating room are generally limited to a relatively small number of procedure types, though surgeons can easily apply the lessons from one surgery to many others. To overcome this limitation, we developed a 3D-printed laparoscopic surgical simulation and navigation system using anatomically accurate bio-elastic wet hemorrhagic organ replica from MDCT data of a patient's skin, bones, blood vessels and abdominal organs. Our hybrid 3D imaging and 3D-printed injection molding technology allowed to manufacturing bio-elastic abdominal wall replica. Based on patient-specific DICOM data from MDCT, after generating its surface polygons using OsiriX application, the multi-material inkjet 3D printer created life-size copies of the 3D organs such as liver, biliary system, pancreas, blood vessels, fat, and abdominal cavity. The replicas were manufactured bio-elastic by simultaneous jetting of different types of materials and injection molding the polyvinyl alcohol (PVA) and water. Each organ’s mold model was given an injection of a synthetic resin that helps make it feel wetter and more lifelike for the surgeon. We evaluated the feasibility of this system in 30 laparoscopic and robotic surgery simulations and navigation. We programed a printer to create clear models made from acrylic resins that allowed us to visualize and understand the complex internal organ structures and blood vessels or the exact tumor locations. It allowed these models realistic stand-in for ultrasonic diagnosis, hepatic intervention and surgical procedure such as cutting, suturing and ligation.
The personalized bio-elastic wet organ replicas were useful for visible and tangible surgical simulation and navigation to plan and guide the successful lap surgeries. With the wet model, surgeons can experience the softness of organs and see them bleed, to help us in practice on lifelike models before stepping into real surgery. Using abdominal cavity replica, there was a place for using synthetic models in realistic surgical situation including laparoscopic and robotic surgeries. The use of these replicas reduced the length of the operation and provided better anatomical reference tools for tailor-made navigation surgery, consequently helping to improve training for the operating room staff, students, and trainees.
These could overcome the limitations of the conventional image-guided laparoscopic navigation. Its combines the advantages of conventional 3D modeling and precise virtual 3D planning in personalized surgical simulation and navigation.
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